Dosin Gilles, Aoun Fouad, El Rassy Elie, Assi Tarek, Lewalle Philippe, Blanc Jeremy, van Velthoven Roland, Bron Dominique
Department of Urology, Jules Bordet Institute, Université Libre de Bruxelles, Brussels, Belgium.
Department of Urology, Jules Bordet Institute, Université Libre de Bruxelles, Brussels, Belgium; Department of Urology, Hotel Dieu de France University Hospital, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon.
Clin Lymphoma Myeloma Leuk. 2017 Jul;17(7):438-442. doi: 10.1016/j.clml.2017.05.013. Epub 2017 May 10.
Hemorrhagic cystitis (HC) is a well-recognized problem that is regularly observed after hematopoietic stem cell transplantation (HSCT). The published data does not report on the potential risk factors for the viral-induced HC that might require prophylactic treatments.
We conducted a retrospective analysis of all adult patients who underwent allogeneic HSCT at Jules Bordet Institute between 1992 and 2013. Our institutional protocol consists in monitoring the patient for signs and symptoms of HC on a daily basis during the initial admission for HSCT, then once weekly after discharge until 2 months thereafter.
HC was found in 64 patients, of whom 56 (87.5%) had viral-induced HC. The median time between HSCT and HC was 39.5 days (range, 1-2766 days); the median time between detection of a viral infection and HC was 32 days (range, 0-2752 days). In multivariate analysis, HC is correlated to the infection with the BK virus (hazard ratio, 6.0; 95% confidence interval, 5.03-6.90; P = .0001) and the adenovirus (hazard ratio, 4.93; 95% confidence interval, 4.06-5.80; P = .0003). The 5-year overall survival of patients with HC was 36%. The 5-year survival rates were not statistically different between patients with or without HC (25% vs. 39%; P = .20).
The presence of the identified risk factors should prompt closer follow-up with screening tests and preventive measures for BK virus and adenovirus infections in patients undergoing HSCT.
出血性膀胱炎（HC）是造血干细胞移植（HSCT）后经常出现的一个公认问题。已发表的数据未报告可能需要预防性治疗的病毒诱导型HC的潜在危险因素。
我们对1992年至2013年间在朱尔斯·博尔德研究所接受异基因HSCT的所有成年患者进行了回顾性分析。我们机构的方案是在HSCT初次入院期间每天监测患者HC的体征和症状，出院后每周监测一次，持续至此后2个月。
64例患者发现有HC，其中56例（87.5%）为病毒诱导型HC。HSCT与HC之间的中位时间为39.5天（范围1 - 2766天）；病毒感染检测与HC之间的中位时间为32天（范围0 - 2752天）。多因素分析显示，HC与BK病毒感染相关（风险比6.0；95%置信区间5.03 - 6.90；P = 0.0001）以及腺病毒感染相关（风险比4.93；95%置信区间4.06 - 5.80；P = 0.0003）。HC患者的5年总生存率为36%。有或无HC患者的5年生存率无统计学差异（25%对39%；P = 0.20）。
已确定的危险因素的存在应促使对接受HSCT的患者进行更密切的随访，采用筛查试验以及针对BK病毒和腺病毒感染的预防措施。
